Health and medical professionals’ antenatal HIV testing practices and perceived barriers to routine testing in Tasmania, Australia: a qualitative study

Objectives: This study sought to explore health and medical professionals’ antenatal HIV testing practices and the perceived barriers to routine testing in Tasmania, Australia.

Design: This qualitative study undertook a Foucauldian-informed discourse analysis of 23 one-to-one semistructured phone interviews. The focus of our analysis was on language as a medium for interactions between clinicians and their patients.

Setting: Primary health care and antenatal health services in the north, northwest and southern Tasmania, Australia.

Participants: Twenty-three health and medical professionals (midwives (n=10), general practitioners (n=9) and obstetricians (n=4)) providing antenatal care.

Results: Antenatal HIV testing is practised within a discourse of ambiguous terminology, stigma and the perception that HIV is a theoretical risk, generating confusion among clinicians as to how and who is tested. This creates clinical hesitancy towards antenatal HIV testing, a barrier to universal prenatal HIV testing.

Conclusion: Antenatal HIV testing is undertaken within a discordant discourse generating clinical hesitancy where HIV is perceived as a theoretical risk and surrounded by stigma. Using neutral language and replacing the words ‘routine’ and ‘recommended’ with ‘universal’ testing in public health policy and clinical guidelines could increase health providers’ confidence and reduce ambiguity and the legacy of HIV stigma.